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Indian Journal of Community Medicine

The changing profile of pregnant women and quality of antenatal care in rural North India

Author(s): Singh A, Arora AK

Vol. 32, No. 2 (2007-04 - 2007-06)

SHORT ARTICLE

Year : 2007 | Volume : 32 | Issue : 2 | Page : 135-136

The changing profile of pregnant women and quality of antenatal care in rural North India

Singh A, Arora AK
Department of Community Medicine, Post Graduate Medical Education and Research, Chandigarh, India
Date of Submission 02-Feb-2006

Correspondence Address:
Singh A
Department of Community Medicine, PGIMER, Chandigarh - 160012
India

Source of Support: None, Conflict of Interest: None

How to cite this article:
Singh A, Arora AK. The changing profile of pregnant women and quality of antenatal care in rural North India. Indian J Community Med 2007;32:135-6

How to cite this URL:
Singh A, Arora AK. The changing profile of pregnant women and quality of antenatal care in rural North India. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:135-6. Available from: http://www.ijcm.org.in/text.asp?2007/32/2/135/35654

A change in the demographic scenario is being witnessed in developing countries like India. There are indications that family size is declining. Accordingly, the profile of pregnant women also seems to be changing. It is important to document such changes in order to give feedback to the planners. Recently, Government of India has launched reproductive and child health-II (RCH-II) program. [1] One of its main focus is on quality of antenatal care (ANC). It is also vital to document the existing quality of ANC in various parts of India. Such information helps in indirectly gauging the progress and impact of the program. Against this background this study was done with an objective to ascertain the fate of pregnancies registered in the study area in order to study the profile of pregnant women and the quality of antenatal care received by them.

Materials and Methods

The study was conducted during 2004 in four purposively selected villages (population - 13733) in the field practice area of department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh. A female social worker first screened 45 years old women of these villages to register pregnant women through a house to house survey. The registered women were followed up every month (till 6 weeks post partum) to record the fate of their pregnancies. They were also interviewed to get details on their sociodemographic and reproductive health data. Consent of the respondents was taken. All data was kept confidential. Manual analysis was done. Pregnancy wastage rate was calculated using the formula = (SB+SA) per year ×100 / Total pregnancies. Fetal death ratio (conventional) was calculated with the formula = (SA) ×100) / (SA +SB+LB) and fetal death, ratio (modified) as = (SA)100 / No. of (SA+SB+LB+½IA)×100.

Results

In the 4 study villages 1013 (7.38%) married women aged 15-45 years were enlisted. Use pattern of family planning methods by these women is given in [Table - 1]. Overall, 266 (26.3%) pregnant women were registered among the enlisted women (1.9% of total population). All were below 29 years (<20 years - 60; 22.5%: 21-24 years - 103; 38.7% and 25-29 years - 103; 38.7%). Literacy rate of study women and their husbands was 75% and 89% respectively.

Seven percent of study population was Muslim and rest were Hindus. Majority (200:75.2%) were from joint families. Rest lived in nuclear families. Most of them were from lower middle or middle class.

In most of the cases (235; 88.3%) there was no home visit by the health worker during pregnancy. In rest, health workers visited the pregnant women at home. Majority of the pregnant women (209; 78.6%) visited the health center for antenatal care. All of them were issued antenatal cards. Three or more visits to the health center were made by 93 (34.9%) cases. Majority of women (153; 57.5%) did not report any problem during pregnancy. Some (29; 10.9%) reported pain in abdomen and 18 (6.8%) reported bleeding. Other problems reported were, weakness (20) backache (15), dragging sensation (5) leakage (2) and injury (2) etc.

Twelve percent (33) women admitted that they got sex determination test done in this pregnancy. Fifty two (19.5%) had taken some oral medicine in this pregnancy. Some laboratory investigation was done during pregnancy in 150 (56.4%) cases. Fate of first pregnancies of the respondents is shown in [Table - 2]. Still birth was reported by 16 cases and spontaneous abortion by 33 cases.

Of the 216 deliveries registered by us after the follow up of the 266 respondents it was a home delivery by a TBA in 126 (58.3%) cases and in 90(41.7%) it was a hospital delivery. (18 cases; 8.3% - private hospitals). Some babies 29 (13.4%) were low birth weight. It was a twin delivery in 4 cases. Spontaneous and induced abortion was reported by 23 cases each. Still birth was reported by 7 cases. Of these, 6 cases were primigravida.

In 84 (31.6%) cases age at marriage was before 18 years. Age at first pregnancy was less than 20 years in 89 (33.4%) cases. In almost half the cases (128;48.1%) the women became pregnant within 12 months of marriage. Another 42.1% (112) women became pregnant within 2 years of marriage. Rest 10% got pregnant between 3-5 years after marriage. Forty three percent (115) of the currently pregnant women were in the first year of their marital life. Forty seven percent (125) were in 2 nd or 3 rd year of their marriage. Rest 10% were married for four year or more. In 123 (46.2%) cases age of the youngest child was less than two years.

Ninety-five (35.7%) couples did not have a child; 48 (18%) each had a son or a daughter. Rest 75 (28.1%) had two or more children. Seventeen women had history of still birth, 50 had spontaneous abortion, 18 had induced abortion and 5 had early neonatal death. Pregnancy wastage rate was 18.4%. Fetal death ratio (conventional) was 12.5% and Fetal death ratio (modified) 12.48%.

Discussion

Our study reflects the change in the profile of pregnant women in rural north India. All the currently pregnant women were younger than 30 years. Most (90%) of them were within second year of their marriage (All were within 5 years of marriage). This reflects that in the contemporary cohort of women (with 1-2 children only), almost all the childbearing was confined to first five years of marriage. This is in contrast with previous scenario where childbearing continued beyond 30 years age and even after 10 years of marriage. This indicates reasonable success of national family welfare program. This also implies that now program's main effort should be directed towards young married women/couples.

Lesser percentage of abortion or still births were reported in current pregnancy as compared to first pregnancy. Almost all reported still births were confined to primigravida. This implies that there is a need to focus on enhancing the quality of antenatal care particularly for primigravida. Our study revealed that over all 2.6% pregnancies resulted in still birth. NFHS-1 [2] had also reported still birth in 2.3% cases. Pregnancy wastage rate (PWR) was estimated to be 18.4% in our study. Earlier also the author had reported a PWR of 16% in this area. [3]

More than one third (38%) women had undergone tubectomy. Vasectomy was reported in 0.4% cases only. Most of these cases had 3 children. Similarly, most of the IUD users had three children. Most of condom or pill users had two children. This indicates the shift in the trend of the preferred contraceptive choice of people for desired family size. Now that people themselves have opted for smaller family size our efforts should be to improve the quality of reproductive health services.

In one-third women each, the age at first pregnancy and at first delivery was less than 18 years and less than 20 years respectively. NFHS-I[2] had reported a median age at marriage for Haryana girls to be 16.3 years while NFHS[2] had reported that 60% girls married before 18 years age. This indicates a need to focus on adolescents particularly with a view to delay their age at marriage. This will improve the chances of survival and better health for both mothers as well as infants/neonates.

Coverage by 3 antenatal visits was 35% in our respondents. Similar rates were reported in NFHS-1.[2] This indicates that situation has not improved much. In our study, home visit by health worker for antenatal care was reported in 15% cases only. Rate of institutional deliveries seems to have reasonably improved (42%). NFHS-1 [2] had reported a rate of 17%. Half of our respondents preferred home deliveries by traditional birth attendants. So, the quality of reproductive maternal health services still needs to be improved further in rural north India.

Twelve percent women admitted to have undergone sex determination tests (SDT) for the current pregnancy. Similar rates were reported in this region by the author earlier.[3] So, despite the ban by the government through PNDT Act the SDTs are still being done in rural north India. This needs to be controlled in view of the highly adverse sex ratio for females in north India.

References

1. Taneja DK. Health Policies and programs in India. 5th ed. Doctors Publication (Regd.): Delhi; 2005.
2. National Family Health Survey I, Haryana 1993. Chandigarh, Population Research Centre, Punjab University and IIPS: Mumbai; 1995.
3. Singh AJ Spontaneous and induced abortion in rural north India. Bull PGI 2003;37:53-8.

Tables

[Table 1: No. of children and family planning methods used]

Table 1: No. of children and family planning methods used

Table 2: Fate of first pregnancy of the subjects (n=266)

Table 2: Fate of first pregnancy of the subjects (n=266)

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